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Cervical screening - the essentials

This week is Cervical Cancer Prevention Week and therefore we thought a timely opportunity to review some of the questions that are asked most frequently.

“What is a smear test?”

A smear test is designed to pick up any abnormal areas on the skin of the cervix where the cells have divided more rapidly than normal. Studies have suggested that cells exhibiting this behaviour might become a cancer if left for a number of years. If we can detect these abnormal areas in the early stages then we can prevent cancers developing which is why regular tests are important, especially between the ages of 25 - 30. That is why delaying a smear test is not advisable. A smear test gathers cells from the skin of the cervix which are then examined under a microscope to determine whether they have a normal appearance or not. Ideally tests should be taken from 20 years of age or alternatively two years after the beginning of sexual activity.

“What is HPV?”

HPV stands for human papillomavirus. We know that it is virtually impossible to get a cancer of the cervix without having an HPV infection first. There are over one hundred different HPV types, some of which are never associated with a cancer and so are called low-risk types. Others however are sometimes associated with a cancer and are called high-risk types. In most tests, we are only looking for high-risk HPV types and ignore the low-risk types. If a test is positive for high-risk HPV, it does not mean that the cells will necessarily be abnormal but they do require closer examination in which case a colposcopy would be recommended. If the HPV test is negative, it is very unlikely that a significant abnormality will be found. If the cells all appear normal, then a repeat smear in six or 12 months’ time is normally recommended.

“I’ve had an abnormal smear? What does this mean?”

First it is important to state that having an abnormal smear doesn’t mean you have cancer. An abnormal smear test suggests at most only very minor changes in the skin of the cervix that can be easily treated. Most commonly, this is only a low-grade change which we tend to manage without treatment. Often low-grade abnormalities will go away without any intervention. A small number of women with low-grade smears will actually have a high-grade abnormality. In such instances we strongly recommend a colposcopy is undertaken to examine the cervix more closely to make sure that a high-grade abnormality is not being missed.

“What is colposcopy?”

Colposcopy is a careful examination of the cervix with a microscope that enlarges the view by about ten times. It’s not dissimilar to a smear test and it takes about five minutes to perform. When colposcopy is performed competently, carefully and sensitively, it should not hurt at all. Colposcopy is normally done without an anaesthetic during the course of a consultation. The results are immediately available and can be discussed at the time of the examination. Often further samples will be taken, such as a repeat smear, a further HPV test or a small biopsy, and these results can take up to a week to come back. If a high-grade abnormality is suspected, a very small skin sample of the area will be taken for a biopsy to be carried out. Results are normally available with 24 - 48 hours.

“What are the treatment options?”

For most women, the changes seen are only low-grade. In that case, we would expect the abnormality to go away without treatment. We usually plan to have a further colposcopy in about six months’ time to keep an eye on the area of abnormal skin and make sure that it is not getting any more significant. If a high-grade abnormality is noted, the usual treatment undertaken in the United Kingdom, is a procedure called a LLETZ in which we remove the area of skin that is abnormal. It is usually done with a small amount of local anaesthetic into the cervix and takes about ten minutes. When performed carefully and sensitively, it should not cause any pain. An alternative to the LLETZ procedure is a NETZ procedure. It is similar to the LLETZ, but uses a needle rather than a pre-formed loop which allows a more precise removal of just the skin that is abnormal. It too is performed under a local anaesthetic and takes just a few minutes.

Following treatment the risk of recurrence varies from about 5 % to 30 %. Some studies have shown that HPV vaccination and the chosen treatment reduces the risk of recurrence by about 50 %.This is presumed to be because it prevents re-infection by HPV. HPV vaccination is very effective at preventing re-infection. In instances of persistent HPV infection we use a treatment called TCA where we use a local application of a chemical to destroy the cells infected with HPV. TCA is about 75 % effective and is usually painless.

“What is the difference between the NHS and the private sector?”

In a word certainty. Certain that you can make an appointment at your convenience and, if needs be, even on the same day. Certain that you will be seen by the same consultant throughout your treatment, with time to discuss results in more detail to make sure that you understand completely the various results and the options for management. Certain that results of any tests undertaken will often be available within 24 - 48 hours and on occasion even the same day. And lastly, that even during the pandemic, all these facilties remain available and therefore help to remove any uncertainty or worry that a patient may be experiencing.

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